Shoulder palsy following SARS-CoV-2 infection: two cases o typical Parsonage-Turner syndrome

Etienne Fortanier (1) , Thomas Le Corroller (2) , Marie Hocquart (3) , Emilien Delmont (1) , Shahram Attarian (4)

1 TIMONE - Hôpital de la Timone [CHU - APHM]
2 ISM - Institut des Sciences du Mouvement Etienne Jules Marey
3 MEPHI - Microbes évolution phylogénie et infections
4 MMG - Marseille medical genetics - Centre de génétique médicale de Marseille

Background and purpose Coronavirus disease 2019 (COVID-19) is now known to cause neurological complications in both the central and the peripheral nervous system. Two new cases of typical neuralgic amyotrophy or Parsonage–Turner (PT) syndrome following coronavirus 2 infection (SARS-CoV-2) are reported here with explicit electrophysiological and imaging pathological features, underlining the possible association between COVID-19 and PT syndrome. Case reports Case 1 was a 45-year-old schoolteacher presenting with acute pain in the right shoulder a few days after SARS-CoV-2 infection, with shoulder abduction and elbow flexion weakness. Needle electromyography showed a decrease in motor unit recruitment in the biceps brachii, and plexus magnetic resonance imaging (MRI) revealed a hyperintense signal involving the right C6 root and the superior truncus of the brachial plexus. Case 2 was a 21-year-old man hospitalized for dyspnea secondary to SARS-CoV-2 infection. Ten days after symptom onset, he presented right shoulder pain with difficulty in raising his right arm, revealing an isolated deficit of the serratus major muscle with a right scapula winging. Electrophysiological evaluation exhibited an isolated involvement of the long thoracic nerve with a neurogenic recruitment pattern in the serratus major muscle. Plexus MRI displayed a thickening and hyperintense signal involving the right long thoracic nerve. Discussion Parsonage–Turner syndrome triggered by SARS-CoV-2 seems to present clinical, electrophysiological and MRI characteristics similar to classic para-infectious PT syndrome, including the time frame between viral infection and neurological symptom onset. Conclusion SARS-CoV-2 might be a new infectious trigger of PT syndrome.

Domains: Life Sciences [q-bio]; Genetics

Etienne Fortanier, Thomas Le Corroller, Marie Hocquart, Emilien Delmont, Shahram Attarian. Shoulder palsy following SARS-CoV-2 infection: two cases o typical Parsonage-Turner syndrome. European Journal of Neurology, 2022, 29 (8), pp.2548-2550. ⟨10.1111/ene.15358⟩. ⟨hal-03780365⟩